Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jill Marie Buckingham, DTR, LICSW

Individual provider Clinical Social Worker · NPI 1235295148

Jill Marie Buckingham, DTR, LICSW is a Clinical Social Worker in Shoreview, Minnesota. Licensed in Minnesota. Registered with an NPI since 2006.

Licensed in
MN
In the registry since
2006
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

3490 Lexington Ave N Ste 205
Shoreview, MN 55126-8044
Phone: (651) 486-3808
Fax: (651) 486-3858
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 12099 (MN)

Record details

NPI number1235295148
Entity typeIndividual (Type 1)
GenderFemale
Credentials DTR , LICSW
Sole proprietorNo
NPI enumeratedDecember 28, 2006
Last updated in NPPESJuly 8, 2007

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